“八二”昆山工厂铝粉尘爆炸事故群体特重度烧伤患者创面处理经验  

Experience of wound treatment on extremely severe mass burn patients involved in August 2nd Kun-shan factory aluminum dust explosion accident

作　　者：寿倍明 谭谦[2] 孙炳伟[3] 聂兰军[4] 沈余明[5] 吕国忠[6] 张逸[7] 林伟[8] 王志学[9] 于冶 赵耀华[11] 王德伟[12] 姚建[13] 谢尔凡[9] 郑东风[2] 肖仕初 章宏伟[15] 洪志坚[16] 王磊[17] 谢文忠 Shou Beiming;Tan Qian;Sun Bingwei;Nie Lanjun;Shen Yuming;Lyu Guozhong;Zhang Yi;Lin Wei;Wang Zhixue;Yu Ye;Zhao Yaohua;Wang Dewei;Yao Jian;Xie Erfan;Zheng Dongfeng;Xiao Shichu;Zhang Hongwei;Hong Zhijian;Wang Lei;Xie Wenzhong(Department of Burns and Plastic Surgery, Nanjing Fire Service Hospital, Nanjing 210003, China)

机构地区：[1]南京公安消防医院烧伤整形科,210003 [2]南京大学医学院附属鼓楼医院整形烧伤科 [3]江苏大学附属医院烧伤整形科 [4]南京医科大学第二附属医院烧伤整形外科 [5]北京积水潭医院烧伤科 [6]无锡市第三人民医院烧伤整形科 [7]南通大学附属医院烧伤整形科 [8]苏州大学附属第一医院烧伤整形外科 [9]苏州市立医院北区烧伤整形科 [10]昆山市第一人民医院烧伤整形科 [11]东南大学医学院附属江阴医院烧伤整形外科 [12]常州市第一人民医院烧伤整形科 [13]南通市第一人民医院烧伤整形科 [14]海军军医大学第一附属医院烧伤外科、全军烧伤研究所 [15]江苏省人民医院烧伤整形科 [16]解放军南京军区总医院烧伤整形科 [17]东南大学附属中大医院烧伤整形科 [18]解放军第一00医院烧伤科

出　　处：《中华烧伤杂志》2018年第6期339-342,共4页Chinese Journal of Burns

摘　　要：目的探讨＂八二＂昆山工厂铝粉尘爆炸事故群体特重度烧伤患者创面处理经验。方法2014年8月2日，98例＂八二＂昆山工厂铝粉尘爆炸事故中的群体特重度烧伤患者收入全国20家医院，病历资料完整纳入本研究，根据手术方式分为微粒植皮组56例患者和Meek植皮组42例患者，于残存皮肤区域切取刃厚皮，分别采用微粒皮移植和Meek微型皮片移植方式进行创面修复。回顾性统计2组患者伤后28 d未封闭创面面积、术后创面感染情况及患者供皮区总体来源。对数据行t检验及χ2检验。结果Meek植皮组患者伤后28 d未封闭创面面积为（59±13）%TBSA，明显小于微粒植皮组的（70±14）%TBSA（t＝4.379，P〈0.05）。术后微粒植皮组中29例患者创面明显感染，Meek植皮组中11例患者创面明显感染。2组患者除了取头皮、躯干、腹股沟及腋窝等处创面周边残存皮肤修复创面外，还从阴囊（4例）、足底（10例）、趾/指蹼（8例）等非常规供皮区取皮修复创面。结论群体特重度烧伤患者首选Meek植皮修复创面，可使创面愈合加快、感染情况减少，皮源奇缺的情况下可从阴囊、足底、趾/指蹼等非常规供皮区取皮进行创面修复。ObjectiveTo explore experience of wound treatment of extremely severe mass burn patients involved in August 2nd Kunshan factory aluminum dust explosion accident.MethodsOn August 2nd, 2014, 98 extremely severe burn mass patients involved in August 2nd Kunshan factory aluminum dust explosion accident were admitted to 20 hospitals in China. The patients with complete medical record were enrolled in the study and divided into microskin graft group with 56 patients and Meek skin graft group with 42 patients. Split-thickness skin in area of residual skin were resected to repair wounds of patients in microskin graft group and Meek skin graft group by microskin grafting and Meek miniature skin grafting, respectively. The residual wound size on 28 days post injury and wound infection after skin grafting of patients in the two groups, and position of donor site of all patients were retrospectively analyzed. Data were processed with t test and chi-square test.ResultsThe size of residual wound of patients in Meek skin graft group on 28 days post injury was （59±13）% total body surface area （TBSA）, which was obviously smaller than that in microskin graft group [（70±14）%TBSA, t=4.379, P〈0.05]. Twenty-nine patients in microskin graft group and 11 patients in Meek skin graft group suffered from obvious wound infection after skin grafting. Wounds of patients in two groups were repaired with residual skin around wound in head, trunk, groin, armpit, and uncommon donor sites of scrotum （4 patients）, vola （10 patients）, and toe or finger web （8 patients）.ConclusionsMeek skin graft is the first choice for wound repair of extremely severe burn mass patients, with faster wound healing, less wound infection. Uncommon donor sites of scrotum, vola, and toe or finger web can also be used for wound repair in case of lack of skin.

关 键 词：烧伤 事故 创面处理 群体烧伤 昆山爆炸 

分 类 号：R644[医药卫生—外科学]